Bone mineral density and markers of bone turnover in patients with renal transplantation and regular hemodialysis

Abstract

Background: Decreased bone mineral density (BMD) is a known complication for the uremic state antedating dialysis / renal transplantation (RTx). The issue of stabilized versus continued decrease of BMD especially on long-term basis, continues to be unresolved. Patients and Methods: 
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"#" hemodialysis (HD-#" $
  
 %    " &'( )&'(-group) had been evaluated for metabolic bone changes by calcium homeostasis parameters (serum calcium, phosphorus, alkaline phosphatase “ALP” and vitamin D “calcitriol”), markers of bone formation (bone alkaline phosphatase “BAP”, osteocalcin “OC”, N-terminal propeptide of collagen type I “PINP”), bone resorption markers (pyridoline “PYL” and deoxypyridoline “DPYL”), and intact parathyroid hormone (iPTH). Also, BMD had been assessed by dual energy x-ray absorptiometry (DEXA) twice, at inclusion time and * ! "  " Results: comparing both groups regarding calcium homeostasis, markers of bone turnover and iPTH showed non significant difference. However, there was a significant drop of BMD (as evidenced by T-score) at follow up in the HD group, compared to stabilization of T-score for the RTx-group. Furthermore, annual T-score change was significantly more in HD-group, compared to RTx-group. Results also showed that, the best marker correlating with T-score annual changes and iPTH to be PINP. Irrespective of normal calcium homeostasis parameters, low BMD is a prevalent disorder among patients on regular HD and renal transplants.Conclusion: Follow up for *!" % +, 
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""! to continued bone loss in patients on regular HD. This could raise recommendation for calcium and calcitriol supplementation, especially in the predialysis period, early post transplantation period, and continued guided replacement for those on maintenance HD. Serum PINP showed best correlations with BMD changes and iPTH and could be considered a reliable marker reflecting bone formation in those patients.